Surgical retractor and method

ABSTRACT

A surgical retractor comprises at least one blade including a first arm and a second arm spaced apart from the first arm. The at least one blade further including a member being disposed with the arms to support at least one surgical instrument in a selected orientation relative to a surgical site. Surgical systems, instruments, constructs, implants and methods are disclosed.

TECHNICAL FIELD

The present disclosure generally relates to medical devices for thetreatment of musculoskeletal disorders, and more particularly to asurgical system and a method for treating a spine.

BACKGROUND

Spinal pathologies and disorders such as scoliosis and other curvatureabnormalities, kyphosis, degenerative disc disease, disc herniation,osteoporosis, spondylolisthesis, stenosis, tumor, and fracture mayresult from factors including trauma, disease and degenerativeconditions caused by injury and aging. Spinal disorders typically resultin symptoms including deformity, pain, nerve damage, and partial orcomplete loss of mobility.

Non-surgical treatments, such as medication, rehabilitation and exercisecan be effective, however, may fail to relieve the symptoms associatedwith these disorders. Surgical treatment of these spinal disordersincludes fusion, fixation, correction, discectomy, laminectomy,corpectomy and implantable prosthetics. As part of these surgicaltreatments, spinal constructs, such as, for example, bone fasteners,spinal rods and interbody devices can be used to provide stability to atreated region. For example, during surgical treatment, surgicalinstruments can be used to deliver components of the spinal constructsto the surgical site for fixation with bone to immobilize a joint.Surgical retractors may be employed during a surgical treatment toprovide access and visualization of a surgical site. Such retractorsspace apart and support tissue and/or other anatomical structures toexpose anatomical structures adjacent the surgical site and/or provide asurgical pathway to the surgical site. This disclosure describes animprovement over these prior technologies.

SUMMARY

In some embodiments, a surgical retractor is provided. The surgicalretractor comprises at least one blade including a first arm and asecond arm spaced apart from the first arm. The at least one bladefurther includes a member being disposed with the arms to support atleast one surgical instrument in a selected orientation relative to asurgical site. In some embodiments, surgical systems, instruments,constructs, implants and methods are disclosed.

In some embodiments, the surgical retractor comprises a first bladeincluding spaced apart arms being connected via a member. The member andthe arms are relatively disposed in a configuration to guide at leastone surgical instrument in a selected orientation relative to a surgicalsite. A second blade is movable relative to the first blade. The secondblade includes spaced apart arms being connected via a member. Themember and the arms of the second blade are relatively disposed in aconfiguration to guide at least one surgical instrument in a selectedorientation relative to the surgical site.

In some embodiments, a surgical system is provided. The surgical systemcomprises at least one blade including a first arm and a second armspaced apart from the first arm. The at least one blade further includesa member disposed with the arms and defining an opening. A retractionrack is connected with the at least one blade. At least one surgicalinstrument is supported by the member and disposable within the openingin a selected orientation relative to a surgical site.

BRIEF DESCRIPTION OF THE DRAWINGS

The present disclosure will become more readily apparent from thespecific description accompanied by the following drawings, in which:

FIG. 1 is a side view of components of one embodiment of a surgicalsystem in accordance with the principles of the present disclosure;

FIG. 2 is a perspective view of the components shown in FIG. 1;

FIG. 3 is a top view of the components shown in FIG. 1;

FIG. 4 is a perspective view of components of one embodiment of a systemin accordance with the principles of the present disclosure disposedwith a patient body;

FIG. 5 is a perspective view of components of one embodiment of a systemin accordance with the principles of the present disclosure disposedwith a patient body;

FIG. 6 is a perspective view of components of one embodiment of asurgical system in accordance with the principles of the presentdisclosure;

FIG. 7 is a side view of the components shown in FIG. 6;

FIG. 8 is a perspective view of components of one embodiment of a systemin accordance with the principles of the present disclosure disposedwith a patient body;

FIG. 9 is a perspective view of components of one embodiment of a systemin accordance with the principles of the present disclosure disposedwith a patient body;

FIG. 10 is a plan view of components of one embodiment of a system inaccordance with the principles of the present disclosure disposed with apatient body;

FIG. 11 is a perspective view of components of one embodiment of asystem in accordance with the principles of the present disclosuredisposed with a patient body;

FIG. 12 is a side view of components of one embodiment of a surgicalsystem in accordance with the principles of the present disclosure;

FIG. 13 is a top view of the components shown in FIG. 12;

FIG. 14 is a perspective view of components of one embodiment of asurgical system in accordance with the principles of the presentdisclosure; and

FIG. 15 side view of a component of a surgical system in accordance withthe principles of the present disclosure.

DETAILED DESCRIPTION

The exemplary embodiments of the surgical system and related methods ofuse disclosed are discussed in terms of medical devices for thetreatment of musculoskeletal disorders and more particularly, in termsof a surgical system for accessing a spine to facilitate treatmentthereof and a method for treating a spine. In some embodiments, thesystems and methods of the present disclosure comprise one or moreretractor blades that are configured to provide selective orientationand positioning of surgical instrumentation and/or support of patientanatomy. In some embodiments, the retractor blade includes surfacesand/or openings to provide selective orientation and positioning ofsurgical instrumentation and/or support of patient anatomy. In someembodiments, the retractor blade includes a cutout that providesinstrumentation and anatomical relief.

In some embodiments, the present surgical system comprises a surgicalinstrument, for example, a surgical retractor blade configured tofacilitate a contralateral decompression and/or a discectomy during amidline posterior thoracolumbar approach by allowing posteriorinstrumentation to be angulated laterally as well as cephalad-caudallyvia surfaces and/or openings of the surgical retractor blade, forexample, surfaces defining a cutout, while maintaining retraction ofsoft tissue out of a working surgical field. In some embodiments, thecutout provides for anatomical relief to facilitate an increase ofinsertion of the retractor into a patient body adjacent to the workingsurgical field without impinging on the facets or the transverseprocesses. In some embodiments, the cut out includes an arcuateconfiguration. In some embodiments, the cut out includes a squareconfiguration.

In some embodiments, the present surgical system comprises a surgicalretractor blade including a surface that defines an opening in a frontplane and/or a top plane of the blade to facilitate manipulation of oneor more surgical instruments. In some embodiments, the surface openingsin the front plane and/or the top plane of the blade allow the one ormore surgical instruments to be angulated laterally and/orcephalad-caudally, while distal surface openings of the blade allow foranatomical relief, for example, along a midline lumbar fusion (MIDLF)surgical approach.

In some embodiments, the present surgical system comprises a surgicalretractor blade including a surface that defines teeth disposed in anarcuate configuration and/or a rectangular cutout that providesanatomical relief and allows the blade to be disposed in the workingsurgical field and/or wound without impinging on the facets or thetransverse processes. In some embodiments, the present surgical systemcomprises a surgical retractor blade including a surface that defines alarge cutout in a front plane and/or a top plane of the blade to allowfor instrumentation to be angulated up to approximately 30 degreesmedial-laterally, as well as up to 20 degrees in the cephalad-caudaldirection, respectively. In some embodiments, the surgical retractorblade facilitates a contra-lateral decompression and discectomy during amidline posterior transforaminal lumbar (TL) surgical approach, whiledecreasing surgical procedure duration.

In some embodiments, the present surgical system can be employed with amethod for treating a spine including the step of connecting and/orslidably engaging one or more surgical retractor blades with a matingretraction rack. In some embodiments, the method includes the step ofmanipulating the retraction rack to laterally translate the blades. Insome embodiments, the method includes the step of manipulating and/ordrawing the blades into tension, thereby retracting an incision in theworking surgical field.

In some embodiments, the present surgical system comprises a surgicalretractor blade including a surface that defines an arc or cutout on adistal end thereof to provide anatomical relief, which allows the bladeto be disposed in the working surgical field and/or wound at a selecteddepth. In some embodiments, this configuration allows surgicalinstrumentation to be angulated and disposed through the cutout, whichopens a working space in the working surgical field and/or wound tofacilitate the procedure, for example, a discectomy. In someembodiments, the present surgical system comprises a surgical retractorblade that can be manufactured via an additive manufacturing process,for example, 3D printing.

The present disclosure may be understood more readily by reference tothe following detailed description of the embodiments taken inconnection with the accompanying drawing figures, which form a part ofthis disclosure. It is to be understood that this application is notlimited to the specific devices, methods, conditions or parametersdescribed and/or shown herein, and that the terminology used herein isfor the purpose of describing particular embodiments by way of exampleonly and is not intended to be limiting. Also, in some embodiments, asused in the specification and including the appended claims, thesingular forms “a,” “an,” and “the” include the plural, and reference toa particular numerical value includes at least that particular value,unless the context clearly dictates otherwise. Ranges may be expressedherein as from “about” or “approximately” one particular value and/or to“about” or “approximately” another particular value. When such a rangeis expressed, another embodiment includes from the one particular valueand/or to the other particular value. Similarly, when values areexpressed as approximations, by use of the antecedent “about,” it willbe understood that the particular value forms another embodiment. It isalso understood that all spatial references, such as, for example,horizontal, vertical, top, upper, lower, bottom, left and right, are forillustrative purposes only and can be varied within the scope of thedisclosure. For example, the references “upper” and “lower” are relativeand used only in the context to the other, and are not necessarily“superior” and “inferior”.

As used in the specification and including the appended claims,“treating” or “treatment” of a disease or condition refers to performinga procedure that may include administering one or more drugs to apatient (human, normal or otherwise or other mammal), employingimplantable devices, and/or employing instruments that treat thedisease, such as, for example, micro discectomy instruments used toremove portions bulging or herniated discs and/or bone spurs, in aneffort to alleviate signs or symptoms of the disease or condition.Alleviation can occur prior to signs or symptoms of the disease orcondition appearing, as well as after their appearance. Thus, treatingor treatment includes preventing or prevention of disease or undesirablecondition (e.g., preventing the disease from occurring in a patient, whomay be predisposed to the disease but has not yet been diagnosed ashaving it). In addition, treating or treatment does not require completealleviation of signs or symptoms, does not require a cure, andspecifically includes procedures that have only a marginal effect on thepatient. Treatment can include inhibiting the disease, e.g., arrestingits development, or relieving the disease, e.g., causing regression ofthe disease. For example, treatment can include reducing acute orchronic inflammation; alleviating pain and mitigating and inducingre-growth of new ligament, bone and other tissues; as an adjunct insurgery; and/or any repair procedure. Also, as used in the specificationand including the appended claims, the term “tissue” includes softtissue, ligaments, tendons, cartilage and/or bone unless specificallyreferred to otherwise.

The following discussion includes a description of a surgical system andrelated methods of employing the surgical system in accordance with theprinciples of the present disclosure. Alternate embodiments are alsodisclosed. Reference is made in detail to the exemplary embodiments ofthe present disclosure, which are illustrated in the accompanyingfigures. Turning to FIGS. 1-5, there are illustrated components of asurgical system 10.

The components of surgical system 10 can be fabricated from biologicallyacceptable materials suitable for medical applications, includingmetals, synthetic polymers, ceramics and bone material and/or theircomposites. For example, the components of surgical system 10,individually or collectively, can be fabricated from materials such asstainless steel alloys, commercially pure titanium, titanium alloys,Grade 5 titanium, super-elastic titanium alloys, cobalt-chrome alloys,stainless steel alloys, super elastic metallic alloys (e.g., Nitinol,super elasto-plastic metals, such as GUM METAL®), ceramics andcomposites thereof such as calcium phosphate (e.g., SKELITE™),thermoplastics such as polyaryletherketone (PAEK) includingpolyetheretherketone (PEEK), polyetherketoneketone (PEKK) andpolyetherketone (PEK), carbon-PEEK composites, PEEK-BaSO₄ polymericrubbers, polyethylene terephthalate (PET), fabric, silicone,polyurethane, silicone-polyurethane copolymers, polymeric rubbers,polyolefin rubbers, hydrogels, semi-rigid and rigid materials,elastomers, rubbers, thermoplastic elastomers, thermoset elastomers,elastomeric composites, rigid polymers including polyphenylene,polyimide, polyimide, polyetherimide, polyethylene, epoxy, bone materialincluding autograft, allograft, xenograft or transgenic cortical and/orcorticocancellous bone, and tissue growth or differentiation factors,partially resorbable materials, such as, for example, composites ofmetals and calcium-based ceramics, composites of PEEK and calcium basedceramics, composites of PEEK with resorbable polymers, totallyresorbable materials, such as, for example, calcium based ceramics suchas calcium phosphate such as hydroxyapatite (HA), corraline HA, biphasiccalcium phosphate, tricalcium phosphate, or fluorapatite, tri-calciumphosphate (TCP), HA-TCP, calcium sulfate, or other resorbable polymerssuch as polyaetide, polyglycolide, polytyrosine carbonate,polycaroplaetohe and their combinations, biocompatible ceramics,mineralized collagen, bioactive glasses, porous metals, bone particles,bone fibers, morselized bone chips, bone morphogenetic proteins (BMP),such as BMP-2, BMP-4, BMP-7, rhBMP-2, or rhBMP-7, demineralized bonematrix (DBM), transforming growth factors (TGF, e.g., TGF-β), osteoblastcells, growth and differentiation factor (GDF), insulin-like growthfactor 1, platelet-derived growth factor, fibroblast growth factor, orany combination thereof.

Various components of surgical system 10 may have material composites,including the above materials, to achieve various desiredcharacteristics such as strength, rigidity, elasticity, compliance,biomechanical performance, durability and radiolucency or imagingpreference. The components of surgical system 10, individually orcollectively, may also be fabricated from a heterogeneous material suchas a combination of two or more of the above-described materials. Thecomponents of surgical system 10 may be monolithically formed,integrally connected or include fastening elements and/or instruments,as described herein.

Surgical system 10 includes a surgical instrument, such as, for example,a surgical retractor 12 (FIG. 4) having a pair of retractor blades, suchas, for example, blade 14 and blade 14 a, similar to blade 14 describedherein. Blade 14 is configured to provide selective orientation andpositioning of a surgical instrument and/or support of patient anatomy.Blade 14 includes surfaces and/or openings to provide the selectiveorientation and positioning of the surgical instrument and/or support ofthe patient anatomy, as described herein. For example, blade 14 isconfigured to support and/or provide limitation of movement of asurgical instrument in a selected orientation relative to a surgicalsite, such as, for example, angulation of a surgical instrument inmedial-lateral orientation and/or a cephalad-caudad orientation during amidline thoracolumbar approach. In some embodiments, surgical retractor12 may include one or a plurality of blades 14.

Blade 14 includes an arm 16 and an arm 18 being spaced apart from arm16, as shown in FIG. 1. Arm 16 includes a portion 24 and a portion 26.Portion 24 extends between an end 20 and an end 22 along an axis X1 in aplane P1. In some embodiments, plane P1 is disposed a cephalad-caudadorientation relative to a patient body B. Portion 24 includes a surface30 configured for engaging and spacing apart tissue. Portion 24 includesa surface 32 extending along axis X1 in plane P1. Surface 32 provides alimit to and/or restricts a range of movement of a surgical instrumentto facilitate selective orientation and positioning of the surgicalinstrument within plane P1, as described herein.

Portion 26 extends along an axis X2 at an angular orientation, such as,for example, perpendicular to axis X1, as shown in FIG. 2. In someembodiments, portion 26 may be oriented in alternate configurations,such as, for example, parallel, co-axial, angularly offset, offsetand/or staggered relative to portion 24. Portion 26 extends between anend 40 and an end 42 along axis X2 in a plane P2. In some embodiments,plane P2 is disposed in a medial-lateral orientation relative to patientbody B. Portion 26 includes a surface 44 that provides a limit to and/orrestricts a range of movement of a surgical instrument to facilitateselective orientation and positioning of the surgical instrument alongplane P1.

Surface 46 extends between arms 16, 18 and is configured to position asurgical instrument in a selected orientation along plane P2. In someembodiments, surface 46 extends perpendicular to axes X2, X4, as shownin FIG. 2. In some embodiments, surface 46 may be oriented in alternateconfigurations, such as, for example, parallel, co-axial, angularlyoffset, offset and/or staggered relative to axes X2, X4.

In some embodiments, all or only a portion of arm 16 may have variouscross-section configurations, such as, for example, arcuate,cylindrical, oblong, rectangular, polygonal, undulating, irregular,uniform, non-uniform, consistent, variable, and/or U-shape. In someembodiments, surface 32, surface 44 and/or surface 46 may have alternatesurface configurations, such as, for example, rough, undulating, porous,semi-porous, dimpled, polished and/or textured.

Arm 18 includes a portion 54 and a portion 56. Portion 54 extendsbetween an end 50 and an end 52 parallel to portion 24 along an axis X3in plane P1. Portion 54 includes a surface 60 configured for engagingand spacing apart tissue. Portion 24 and portion 54 are spaced apart toform an opening 58 along plane P1 for disposal of a surgical instrumentin a selected orientation along plane P1. Portion 54 includes a surface62 that provides a limit to and/or restricts a range of movement of asurgical instrument to facilitate selective orientation and positioningof the surgical instrument along plane P1.

Portion 56 extends along an axis X4, disposed parallel to axis X2, andat an angular orientation, such as, for example, perpendicular to axisX3, as shown in FIG. 2. In some embodiments, portion 56 may be orientedin alternate configurations, such as, for example, parallel, co-axial,angularly offset, offset and/or staggered relative to portion 54.Portion 56 extends between an end 70 and an end 72 along axis X4 inplane P2, as described herein. Portion 26 and portion 56 are spacedapart to form an opening 59 along plane P2 for disposal of a surgicalinstrument in a selected orientation along plane P1 and/or P2. Portion56 includes a surface 74, as shown in FIG. 3, which provides a limit toand/or restricts a range of movement of a surgical instrument tofacilitate selective orientation and positioning of the surgicalinstrument along plane P1. Openings 58, 59 are disposed in communicationto facilitate movement of a surgical instrument along planes P1, P2.

In some embodiments, all or only a portion of arm 18 may have variouscross-section configurations, such as, for example, arcuate,cylindrical, oblong, rectangular, polygonal, undulating, irregular,uniform, non-uniform, consistent, variable, and/or U-shape. In someembodiments, surface 62 and/or surface 76 may have alternate surfaceconfigurations, such as, for example, rough, undulating, porous,semi-porous, dimpled, polished and/or textured.

Blade 14 includes a member 80. Member 80 is connected with ends 22, 52of arms 16, 18. Member 80 is disposed with arms 16, 18 to support,position, provide a limit and/or restrict a range of movement of asurgical instrument in a selected orientation relative to the surgicalsite. Member 80 includes a surface 82 having an arcuate configuration.Surface 82 is curved in a convex configuration between ends 22, 52 suchthat surface 82 provides for anatomical relief of body tissue. In someembodiments, surface 82 facilitates an increase of insertion ofretractor 12 into patient body B adjacent to a working surgical field.In some embodiments, surface 82 is configured for insertion with apatient body B without impinging on the facets or the transverseprocesses. Surface 82 includes a plurality of teeth 84 extendingtransverse to surface 82, as shown in FIG. 2. Teeth 84 are configured tofacilitate capture and/or separation of tissue. Member 80 includes asurface 86 disposed adjacent to surfaces 32, 62 to support, provide alimit and/or restrict a range of movement of a surgical instrument in aselected orientation relative to the surgical site.

Surfaces 32, 44, 62, 74 and/or 86 provide a limit to and/or restrict arange of movement of a surgical instrument to facilitate selectiveorientation and positioning of the surgical instrument, for example,along a cephalad-caudal direction relative to vertebral tissue withinopenings 58, 59 along plane P1. For example, the working end of asurgical instrument is engaged with and fixed with vertebral tissue. Insome embodiments, the handle end of the surgical instrument is moveablethrough an angular range of 0 through 60 degrees relative to vertebraltissue along plane P1. In some embodiments, a surgical instrument ismoveable through an angular range of 0 through 20 degrees relative tovertebral tissue along plane P1. Contact of a surgical instrument withsurfaces 32, 44, 62, 74 and/or 86 provide limits on the range ofmovement and/or rotation of the surgical instrument through the angularrange in plane P1.

Surfaces 46 and/or 86 provide a limit to and/or restrict a range ofmovement of a surgical instrument to facilitate selective orientationand positioning of the surgical instrument along, for example, amedial-lateral direction relative to the vertebral tissue withinopenings 58, 59 along plane P2. For example, the working end of thesurgical instrument is engaged with and is fixed with vertebral tissue.In some embodiments, the handle end of the surgical instrument ismoveable through an angular range of 0 through 40 degrees relative tovertebral tissue within plane P2. In some embodiments, the surgicalinstrument is moveable through an angular range of 0 through 30 degreesrelative to vertebral tissue within plane P2. Contact of a surgicalinstrument with surfaces 46, 86 provide limits on the range of movementand/or rotation of the surgical instrument through the angular range inplane P2.

Ends 40, 70 include a mating portion 90 that extends along surface 46.Portion 90 includes a surface 92 that defines an opening 94. Opening 94is configured for disposal of jogs 102 of retraction rack 100, as shownin FIG. 4. Blade 14 is attached with rack 100 for relative translationto space apart tissue. In some embodiments, a ratchet mechanism on rack100 is configured to facilitate retraction of tissue. Blade 14 isattached with a rack 100 such that blade 14 is movable in one or aplurality of degrees of freedom to one or a plurality of orientationsrelative to rack 100, stationary surgical equipment and/or the patientbody B in connection with a surgical procedure. In some embodiments, thedegrees of freedom of movement of blade 14 to one or a plurality oforientations relative to rack 100, stationary surgical equipment and/orpatient body B can include one or a plurality of degrees of movement intranslation, one or a plurality of degrees of movement in rotation,planar movement such as a four bar linkage, spherical movement such aspoly-axial and/or joints or links such as a kinematic chain. In someembodiments, the degrees of movement in translation can include up,down, left, right, forward and/or backward. In some embodiments, thedegrees of movement in rotation can include tilting, swiveling and/orpivoting in one or a plurality directions. In some embodiments, blade 14is independently and selectively movable relative to rack 100,stationary surgical equipment and/or patient body B. In someembodiments, one or a plurality of blades 14 may be attachable with rack100.

In some embodiments, retractor 12 may be employed with various surgicalinstruments, such as, for example, drivers, extenders, reducers,spreaders, distractors, clamps, forceps, elevators and drills, which maybe alternately sized and dimensioned, and arranged as a kit. In someembodiments, surgical system 10 may comprise the use of microsurgicaland image guided technologies, such as, for example, surgical navigationcomponents employing emitters and sensors, which may be employed totrack introduction and/or delivery of the components of surgical system10 including the surgical instruments to a surgical site. See, forexample, the surgical navigation components and their use as describedin U.S. Pat. Nos. 6,021,343, 6,725,080, 6,796,988, the entire contentsof each of these references being incorporated by reference herein.

In assembly, operation and use, surgical system 10, similar to thesystems and methods described herein, is employed with a surgicalprocedure for treatment of a spinal disorder, such as those describedherein, affecting a section of a spine of a patient. Surgical system 10may also be employed with other surgical procedures. In someembodiments, surgical system 10 is employed to implant components, suchas bone fasteners, rods, interbody devices and plates, with patient bodyB, as shown in FIGS. 4 and 5.

With the body disposed in a selected orientation, for example, for amidline posterior TL surgical approach for a contra-lateraldecompression and discectomy, a medical practitioner makes and/orcreates an incision in tissue, which includes soft tissue and/or muscle,to obtain access to a surgical site including affected vertebral levelsof vertebrae V. The tissue is manipulated to space the tissue adjacentto the incision.

Surgical retractor 12, as described herein, is disposed with theincision for spacing tissue. Blades 14, 14 a, as described herein, areconnected with rack 100. Blades 14, 14 a are relatively moveable andconfigured for insertion sequentially around the intervertebral space.Surfaces 280, 280 a are positioned to provide anatomical relief andallow blades 14, 14 a to be disposed in the working surgical fieldwithout impinging on the facets or the transverse processes, asdescribed herein. Blades 14, 14 a are manipulated for movement by rack100, as described herein, relative to vertebrae V.

Opening 59 is oriented in plane P2 that is disposed in thecephalad-caudal direction of vertebrae V and opening 58 is oriented inplane P1 disposed in a medial-lateral direction relative to vertebrae V.A surgical instrument 500 is inserted through opening 59 and opening 58,as shown in FIG. 4. As surgical instrument 500 is manipulated, contactwith surfaces 32, 44, 62, 74 and/or 86 provide a limit to and/orrestrict a range of movement of a surgical instrument, as describedherein, to facilitate selective orientation and positioning of surgicalinstrument 500 in the cephalad-caudal direction, as shown by arrows A inFIG. 5, within opening 59 and opening 58.

As surgical instrument 500 is manipulated, contact with surfaces 46and/or 86 provide a limit to and/or restrict a range of movement ofsurgical instrument 500 in the medial-lateral direction within opening59 and opening 58, as shown by arrows B in FIG. 5. Surgical instrument500 is moveable through an angular range of 0 through 30 degreesrelative to vertebrae V along the medial-lateral direction of vertebraeV. Surgical instrument 500 is moveable through an angular range of 0through 20 degrees relative vertebrae V along the cephalad-caudaldirection of vertebrae V.

In some embodiments, pilot holes or the like are made in vertebrae Vadjacent the intervertebral space for receiving bone fasteners and/orattaching spinal constructs, which may include rods and plates. Aninserter is attached with the implants and/or spinal constructs fordelivery adjacent to a surgical site for implantation adjacent one ormore vertebra and/or intervertebral spaces of the vertebral levels.

Upon completion of a procedure, as described herein, the surgicalinstruments, assemblies and non-implanted components of surgical system10 are removed and the incision(s) are closed. One or more of thecomponents of surgical system 10 can be made of radiolucent materialssuch as polymers. Radiopaque markers may be included for identificationunder x-ray, fluoroscopy, CT or other imaging techniques. In someembodiments, the use of surgical navigation, microsurgical and imageguided technologies, as described herein, may be employed to access,view and repair spinal deterioration or damage, with the aid of surgicalsystem 10. In some embodiments, surgical system 10 may include implantsand/or spinal constructs, which may include one or a plurality ofplates, rods, connectors and/or bone fasteners for use with a singlevertebral level or a plurality of vertebral levels.

In one embodiment, as shown in FIGS. 6-11, surgical system 10, similarto the systems and methods described herein, includes a retractor 220,similar to retractor 12 described herein, and includes a blade 214.Blade 214 includes an arm 216 and an arm 218 being spaced apart from arm216 forming an opening 217 to guide the surgical instrument along theselected orientation, as shown in FIG. 6. Arm 216 includes a portion 224and a portion 226. Portion 224 extends between an end 220 and an end 222in plane P1, similar to portion 24 described herein. Portion 224includes a surface 230 configured for engaging and spacing apart tissue.Portion 224 includes a surface 232 that provides a limit to and/orrestricts a range of movement of a surgical instrument to facilitateselective orientation and positioning of the surgical instrument alongplane P1, similar to surface 32 described herein. End 222 includes adistal tip 238 having an arcuate configuration angled to capture and/orseparate tissue. Tip 238 includes a plurality of teeth 284, as shown inFIG. 6. Teeth 284 are configured to facilitate capture and/or separationof tissue.

Portion 226 extends between an end 240 and an end 242 along plane P2,similar to portion 26 described herein. Portion 226 includes a surface244. Surface 244 that provides a limit to and/or restricts a range ofmovement of a surgical instrument to facilitate selective orientationand positioning of the surgical instrument along plane P1, similar tothat described herein. Surface 246, similar to surface 46 describedherein, extends between arms 216, 218 and provides a limit to and/orrestricts a range of movement of a surgical instrument to facilitateselective orientation and positioning of the surgical instrument alongplane P2, similar to surface 46 described herein.

Arm 218 includes a portion 254 and a portion 256. Portion 254 extendsbetween an end 250 and an end 252 in plane P1 and is disposed parallelto portion 224. Portion 254 includes a surface 260 configured forengaging and spacing apart tissue. Portion 254 includes a surface 262that provides a limit to and/or restricts a range of movement of asurgical instrument to facilitate selective orientation and positioningof the surgical instrument along plane P1, similar to surface 62described herein. End 252 includes a distal tip 258 having an arcuateconfiguration angled to capture and/or separate tissue. Tip 258 includesa plurality of teeth 285, as shown in FIG. 6. Teeth 285 are configuredto facilitate capture and/or separation of tissue. Portion 224 andportion 254 are spaced apart to form an opening 257 disposed along planeP1 for disposal of a surgical instrument along a selected orientation inplane P1, similar to opening 58 described herein.

Portion 256 extends between an end 270 and an end 272, similar toportion 56 described herein. Portion 256 includes a surface 274, asshown in FIG. 6. Surface 274 and surface 262 are configured to positiona surgical instrument in a selected orientation within plane P1, asdescribed herein. Surface 246 provides a limit to and/or restricts arange of movement of a surgical instrument to facilitate selectiveorientation and positioning of the surgical instrument along plane P2.Portion 226 and portion 256 are spaced apart to form an opening 259disposed along plane P2 for disposal of the surgical instrument alongthe selected orientation in plane P1 and/or P2, similar to opening 59described herein.

Blade 214 includes a member 280, similar to member 80 described herein.Member 280 is connected with arms 216, 218. Member 280 is disposedsubstantially perpendicular relative to arms 216, 218, as shown in FIG.7. Member 280 is disposed a distance from tips 238, 258 forming a cutout286. Cutout 286 provides for anatomical relief and facilitates anincrease of insertion of retractor 212 into patient body B adjacent to aworking surgical field, as described herein. Cutout 286 is configured toresist and/or prevent impinging the facets or the transverse processes.Member 280 includes a surface 288 disposed adjacent to surfaces 232, 262to provide a limit to and/or restrict a range of movement of a surgicalinstrument to facilitate selective orientation and positioning of thesurgical instrument in the selected orientation relative to the surgicalsite.

Ends 240, 270 include a mating portion 290 that extends along surface246, as described herein. Portion 290 includes a surface 292 thatdefines an opening 294. Opening 294 is configured for disposal of aretraction rack 100, as described herein.

In use, as shown in FIGS. 8-11, as surgical instrument 500 ismanipulated, contact with surfaces 232, 244, 262, 274 and/or 288 providea limit and/or restriction to a range of movement of surgical instrument500 for disposal in a selected orientation, for example, acephalad-caudal direction relative to vertebral tissue, within openings257, 259 along plane P1. For example, a working end of surgicalinstrument 500 is engaged with and fixed with vertebrae V. A handle endof surgical instrument 500 is moveable through an angular range of 0through 20 degrees relative to vertebrae V within plane P1, as shown inFIG. 10. Contact with surfaces 232, 244, 262, 274 and/or 288 providelimits on the range of movement and/or rotation of surgical instrument500 through the angular range in plane P1.

As surgical instrument 500 is manipulated, contact with surfaces 246and/or 288 provide a limit and/or restriction on a range of movement ofsurgical instrument 500 for disposal in a selected orientation, forexample, a medial-lateral direction relative to vertebral tissue withinopenings 257, 259 along plane P2. For example, surgical instrument 500is fixed with vertebrae V and is moveable through an angular range of 0through 30 degrees relative to vertebrae V along plane P2, as shown inFIG. 11. Contact with surfaces 246 and 288 provide limits on the rangeof movement and/or rotation of the surgical instrument through theangular range in plane P2.

In one embodiment, as shown in FIGS. 12 and 13, surgical system 10,similar to the systems and methods described herein, includes aretractor 412, similar to retractor 12 described herein. Retractor 412includes a blade 414 for, similar to blade 14 described herein. Blade414 is configured to provide selective orientation and positioning of asurgical instrument and/or support of patient anatomy, as describedherein.

Blade 414 includes an arm 416 and an arm 418 being spaced apart from arm416, as shown in FIG. 13. Arm 416 includes a portion 424 and a portion426. Portion 424 includes a section 424 a and a second 424 b. Section424 a extends along an axis X5 in a plane P3. In some embodiments, planeP3 is disposed a cephalad-caudad orientation relative to a patient bodyB. Section 424 b extends along an axis X6. Axis X6 is disposed at anangle a relative to axis X5 and/or plane P3. In some embodiments, anglea is configurated as an obtuse angle, as shown in FIG. 12. In someembodiments, angle a may be acute or perpendicular. In some embodiments,section 424 b may be oriented in alternate configurations, such as, forexample, parallel, co-axial, angularly offset, offset and/or staggeredrelative to section 424 a. The angular orientation of section 424 b tosection 424 a is configured to increase purchase of blade 414 withtissue. In some embodiments, the angular orientation of section 424 b tosection 424 a is configured to maximize working space distally andresists and/or prevents impingement on bony anatomy, such as, forexample, facets or transverse processes.

In one embodiment, as shown in FIGS. 14 and 15, surgical system 10,similar to the systems and methods described herein, includes aretractor 512, similar to retractor 12 described herein. Retractor 512includes a blade 514 for, similar to blade 14 described herein. Blade514 is configured to provide selective orientation and positioning of asurgical instrument and/or support of patient anatomy, as describedherein.

Blade 514 includes an arm 516 and an arm 518 being spaced apart from arm516, as shown in FIG. 14. Arm 516 includes a portion 524, similar toportion 24 and a portion 526, similar to portion 26, as describedherein. Portion 524 includes a surface 530 that defines an opening 532and an opening 534. A channel 536 extends between openings 532, 534.Channel 536 is configured for disposal of a light source 700, as shownin FIG. 15. Light source 700 is guided through channel 536 to providelight to the working space at the surgical site.

Arm 518 includes a portion 624, similar to portion 24 and a portion 626,similar to portion 26, as described herein. Portion 624 includes asurface 630 that defines an opening 632 and an opening 634. A channel536 extends between openings 632, 634. Channel 536 is configured fordisposal of light source 700, as described herein.

Portion 526 and portion 626 each include a flange, such as, for example,a hook 650, as shown in FIG. 14. Hooks 650 are configured to facilitateorganization of extensions and/or cables 702 extending from light source700. In some embodiments, hooks 650 are configured to resist and/orprevent cables 702 from obstructing visualization the surgical siteand/or the ability to operate in the working space.

It will be understood that various modifications and/or combinations maybe made to the embodiments disclosed herein. Therefore, the abovedescription should not be construed as limiting, but merely asexemplification of the various embodiments. Those skilled in the artwill envision other modifications within the scope and spirit of theclaims appended hereto.

What is claimed is:
 1. A surgical retractor comprising: a longitudinalelement extending along a longitudinal axis between opposite first andsecond ends; a first extension coupled to the first end; a secondextension coupled to the second end such that the second extension isconfigured to slide linearly relative to the longitudinal element alongthe longitudinal axis; a first blade including a first arm and a secondarm, proximal ends of the first and second arms being coupled to thefirst extension, distal ends of the first and second arms beingconnected by a member, the first arm being spaced apart from the secondarm between the first extension and the member, the member beingdisposed with the first and second arms to support at least one surgicalinstrument in a selected orientation relative to a surgical site; and asecond blade coupled to the second extension, wherein the first bladeand the second blade are radiolucent.
 2. A surgical retractor as recitedin claim 1, wherein: the first arm includes a first portion and a secondportion disposed at an angular orientation relative to the first portionof the first arm; the second arm includes a first portion and a secondportion disposed at an angular orientation relative to the first portionof the second arm; and the first portions of the first and second armsdefine a first plane and the second portions of the first and secondarms define a second plane disposed at a perpendicular orientationrelative to the first plane.
 3. A surgical retractor as recited in claim1, wherein the member includes a linear configuration.
 4. A surgicalretractor as recited in claim 1, wherein the member includes an arcuateconfiguration.
 5. A surgical retractor as recited in claim 1, whereinthe member includes a plurality of teeth.
 6. A surgical retractor asrecited in claim 1, wherein the member is coupled to tips of the distalends of the first and second arms.
 7. A surgical retractor as recited inclaim 1, wherein the second extension is slidable relative to the firstextension in opposite directions along a length of the longitudinalelement.
 8. A surgical retractor as recited in claim 1, wherein thefirst extension is fixed relative to the longitudinal element and thesecond extension is slidable along the longitudinal element.
 9. Asurgical retractor as recited in claim 1, wherein the first extensionincludes a first portion that is coupled directly to the longitudinalelement and a second portion that is offset relative to the firstportion, the first blade being coupled to the second portion, the secondextension being slidable along the longitudinal element.
 10. A surgicalretractor as recited in claim 1, wherein the first and second extensionseach include a linear first portion, a linear second portion and alinear third portion, the second portion being positioned between thefirst portion and the third portion, the first portion being coupleddirectly to the longitudinal element, the first portion and the thirdportion extending perpendicular to the longitudinal element, the secondportion extending at an acute angle relative to the longitudinalelement.
 11. A surgical retractor as recited in claim 1, wherein themember includes teeth, the second extension being movable relative tothe first extension along the longitudinal element between a firstorientation in which the first blade is spaced apart from the secondblade and a second orientation in which the first blade directly engagesthe second blade, the teeth of the member being spaced apart from thesecond blade when the second extension is in the second orientation. 12.A surgical retractor as recited in claim 1, wherein the first extensionincludes a linear first portion, a linear second portion and a linearthird portion, the second portion being positioned between the firstportion and the third portion, the first portion being coupled directlyto the longitudinal element, the first and second arms being coupleddirectly to the third portion, the first portion and the third portionextending perpendicular to the longitudinal element, the second portionextending at an acute angle relative to the longitudinal element.
 13. Asurgical retractor as recited in claim 1, wherein the first arm isspaced apart from the second arm by an opening that extends from theextension to the member.
 14. A surgical retractor as recited in claim 1,wherein the first blade is monolithic.
 15. A surgical retractor asrecited in claim 1, wherein the first extension is fixed relative to thelongitudinal element.
 16. A surgical retractor as recited in claim 1,wherein the longitudinal element is free of teeth.
 17. A surgicalretractor as recited in claim 1, wherein the proximal ends of the firstand second arms each extend parallel to the longitudinal element and thedistal ends of the first and second arms each extend perpendicular tothe longitudinal element, the first arm being spaced apart from thesecond arm between the extension and the member to define an openingthat extends between the proximal ends and the distal ends of the firstand second arms.
 18. A surgical retractor as recited in claim 1, whereinthe first and second arms each further include a first portion and asecond portion disposed at an angular orientation relative to the firstportion, the first portion of each of the first and second arms directlyengaging the longitudinal element and defining a first plane, the secondportion of each of the first and second arms defining a second planedisposed at a perpendicular orientation relative to the first plane, themember including a plurality of teeth, at least a portion of each of theteeth being disposed in a third plane, the third plane being parallel tothe first plane.
 19. A surgical retractor comprising: a longitudinalelement extending along a longitudinal axis between opposite first andsecond ends; a first extension coupled to the first end such that thefirst extension is fixed relative to the longitudinal element along thelongitudinal axis; a second extension coupled to the second end suchthat the second extension is configured to slide linearly relative tothe longitudinal element in opposite directions along the longitudinalaxis; a first blade including a first arm and a second arm, proximalends of the arms being coupled to the first extension, distal ends ofthe first and second arms being connected via a member, the first armbeing spaced apart from the second arm from the first extension to themember, the member and the first and second arms being relativelydisposed in a configuration to guide at least one surgical instrument ina selected orientation relative to a surgical site; and a second bladecoupled to the second extension such that the second blade is movablerelative to the first blade, the second blade including spaced apartarms being connected via a member, the member of the second blade andthe spaced apart arms of the second blade being relatively disposed in aconfiguration to guide at least one surgical instrument in a selectedorientation relative to the surgical site, wherein the first blade andthe second blade are radiolucent.
 20. A surgical system comprising: alongitudinal element extending along a longitudinal axis betweenopposite first and second ends; a first extension coupled to the firstend such that the first extension is fixed relative to the longitudinalelement along the longitudinal axis and is pivotable relative to thelongitudinal element about a pivot axis that extends parallel to thelongitudinal axis; a second extension comprising a housing having thesecond end disposed therein such that the second extension is configuredto slide linearly relative to the longitudinal element in oppositedirections along the longitudinal axis; a first blade including a firstarm and a second arm, proximal ends of the first and second arms beingcoupled to the first extension, distal ends of the first and second armsbeing connected by a member, the first arm being spaced apart from thesecond arm from the first extension to the member to define an opening;a second blade coupled to the second extension, wherein the first bladeand the second blade are radiolucent; and at least one surgicalinstrument being supported by the member and disposable within theopening in a selected orientation relative to a surgical site.